Opinion statement

Patients with either primary or metastatic brain tumors quite often have cognitive impairment. Maintaining cognitive function is important to brain tumor patients and a decline in cognitive function is generally accompanied by a decline in functional independence and performance status. Cognitive decline can be a result of tumor progression, depression/anxiety, fatigue/sleep dysfunction, or the treatments they have received. It is our opinion that providers treating brain tumor patients should obtain pre-treatment and serial cognitive testing in their patients and offer mitigating and therapeutic interventions when appropriate. They should also support cognition-focused clinical trials.

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Conflict of Interest

Christina K. Cramer has received speaker’s honoraria from Monteris Medical, and is also a member of teaching faculty for an on-site SBRT training course to which Elekta refers customers and for which Elekta reimburses the department.

Tiffany L. Cummings declares that she has no conflict of interest.

Rachel N. Andrews declares that she has no conflict of interest.

Michael Chan has received speaker’s honoraria from Monteris Medical, and is also a member of teaching faculty for an on-site SBRT training course to which Elekta refers customers and for which Elekta reimburses the department.

Roy Strowd declares that he has no conflict of interest.

Stephen R. Rapp declares that he has no conflict of interest.

Edward G. Shaw declares that he has no conflict of interest.

Glenn J. Lesser has received clinical trial support from Vascular Biogenics, Incyte, NewLink Genetics, Novartis, Immunocellular Therapeutics, and Pfizer; has received compensation from Monteris Medical and Insys Therapeutics for service as a consultant; and has received compensation from Stemline Therapeutics for serving as Data Safety and Monitoring Board Chair for a study.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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•• Brown PD, Ballman KV, Cerhan JH, Anderson SK, Carrero XW, Whitton AC, et al. Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC.3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol. 2017;18(8):1049–60 NCGTGN107C/CEC 3 offered confirmation that cognitive-deterioration-free survival is longer in patients receiving SRS compared to WBRT. In this phase III trial, 194 patients who had undergone resection for a brain metastasis < 5 cm were randomized to postoperative SRS to the surgical cavity or WBRT [90]. At 6 months, 52% of patients receiving SRS had cognitive decline compared with 85% of the patients receiving WBRT. Again, there was no difference seen in survival between the two groups. This was a landmark trial and will likely serve as a benchmark and historical control study for some years to come.PubMedPubMedCentralGoogle Scholar